Family planing 2012


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FOWODE conducted a Public Expenditure Tracking Survey (PETS) to track the flow of family planning funds in Uganda. In total 20 Health Center IIIs and 10 Health Center IVs were randomly but proportionately selected from the districts of Luwero, Kabale, Kibaale, Gulu and Kibuku and data was gathered from the Ministry of Health, National Medical Stores and the United Nations Population Fund on the flow of family planning funds/services. This Issues Brief contains key findings and recommendations

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Family planing 2012

  2. 2. WHERE IS THE MONEY FORFAMILY PLANNING SERVICES IN UGANDAis published by Forum for Women and Democracy(FOWODE) with support from the Results forDevelopment (R4D)© 2012Forum for Women in Democracy (FOWODE)P.O. Box 7176, KampalaTel: +256-41-286063E-mail: fowode@fowode.orgWeb www.fowode.orgAll rights reserved. No part of this publication maybe reproduced, or reprinted in any form by anymeans without the prior permission of the copyrightholder. Nevertheless, FOWODE and Results forDevelopment (R4D) encourage its use and will behappy if excerpts are copied and used. When doingso, however please acknowledge FOWODE. 2
  3. 3. WHERE IS THE MONEY FOR FAMILY PLANNINGSERVICES IN UGANDA?Forum for Women in Democracy (FOWODE)conducted a Public Expenditure Tracking Survey(PETS) of funds/materials allocated to FamilyPlanning (FP) services right from the Ministryof Finance Planning and Economic Development(MFPED) through the Ministry of Health (MoH),National Medical Stores (NMS) and Health Centers(HCs) III and IV where family planning services areaccessed by women at the grassroots communitiesin five districts of Uganda . The research sought toanswer the following key questions:1. What are the Family Planning services provided at the facility level?2. How are funds/materials transferred from the central level to the health units3. What is allocated in the budget for Family Planning services?4. Do the money/materials reach the health unit? What guidelines/mechanisms are in place for ensuring accountability of funds released for Family Planning services?Key issues• Only UGX 1,846,897,798 was allocated to Family Planning by the government of Uganda for the FY 2010/11• Donors provided US $ 9,657,095, which is over 10 times Uganda government’s funding for Family Planning commodities.• Government expenditure on Family Planning Commodities was on commodities that can only be used by women; implants, IUDs and Depo Provera 3
  4. 4. • Overall, dispensing constituted only 40.0% of what was actually received by health units.• 17 out of the 30 surveyed health units lacked separate cabins for storage of documents. There was an additional challenge of lack of qualified records assistants in half of the Health Centers surveyed.Health Unit Management Committees (HUMCs)played no oversight roles in the management ofFamily Planning services including participatingin accounting to the District Health Officers andcommunities.Research Findings1. Financing Family Planning: The study discovered that donors provided the bulk of funding for family planning in Uganda. In FY 2010/11 Only UG shs 1,846,897,798 (equivalent to USD 923,440) was allocated to Family Planning while donors notably UNFPA, USAID and DFID spent USD 9,657,095 on family planning during the same period.Figure 1: Government Vs Donor fundingtowards Family Planning services 4
  5. 5. Government’s per capita expenditure on familyplanning commodities for women of reproductiveage was UG shs 223 of USD 0.09 while Donor’sper capita expenditure on family planningcommodities for women and men of reproductiveage amounts to USD. 0.56. If the demand for FamilyPlanning commodities was to rise, US $ 7.4 is therecommended per capita expenditure.Government should substantially increase itsallocations for family planning commodities to US$ 7.4 per capita.Government expenditure on Family Planning wason commodities that can only be used by women;implants, IUDs and Depo Provera.Figure 2: Government expenditure on FamilyPlanning Commodities.Government should also procure family planningcommodities used by men, especially condoms.2. Family Planning Services Offered at Health Units: Family planning services (commodities and requisite surgery where necessary) provided at health facility level differ by level of facility, personnel and equipment available 5
  6. 6. at the facility. For example, IUDs and implants are not provided at Health Center IIIs Miriam disputes this. These services are provided at Health Center IVs which should ideally have a medical doctor and a theater. However, not all health centre IVs have medical doctors and/ or theaters. Of the 10 surveyed Health Centre IVs, only 4 (Kakindo in Kibaale, Awach in Gulu, Nyimbwa and Luwero both in Luwero district) had doctors. Health Center IVs lacking doctors can therefore not provide services like IUDs and implants. All Center IVs should have skilled medical personnel and surgical equipments required for family planning services. Planning Commodities. Whereas the3. Tools for Delivery and Receipt of Family NMS and health units utilize the tools for delivery and receipt of family planning 6
  7. 7. commodities, respectively, there is still room for improvement. The survey revealed discrepancies in the records of supplies both at the National Medical Stores and several health units for most health centers. First, NMS delivery notes are written in Entebbe with details of dates, types and quantities of FP commodities to be delivered to each health unit. Ideally, health units ought to sign the delivery notes upon verifying the types and quantities actually delivered. But in several cases, the delivery forms are signed when the quantities indicated as delivered are less or more than what is written on the NMS delivery forms. In other words, in several cases, health units’ countersigning of delivery notes is perfunctory. See examples in the table below: Period District National Health Center Received records Medical Stores Delivery records Muko Health Commodities worth Commodities worth Center IV, Kabale US $ 2,677.6 were US $ 6,891.05 were received. FY delivered 2010/11 Kamukira Health Commodities worth Commodities worth only Center IV, Kabale US $ 5,800.805 US $ 1,545.355 were received were delivered Nabuli Health Commodities worth Commodities worth only US $ 499 Center III, Kibuku US $ 745.5 were were received delivered to   7
  8. 8. There was a general lack of qualified record3.1 Lack of qualified Records Assistants: assistants in over half of the health centers surveyed. Records were in some units made by midwives because family planning commodities were associated with maternal health, but some are overwhelmed with numbers of expectant mothers to attend to; hence no time to even record in-coming and dispensed commodities. In other cases, staff tasked with making entries into stock cards could not distinguish between different types of commodities. For example in Zirobwe Health Center III, it was observed that the stores and records assistant always failed to distinguish between Levonorogestrel 0.03mg 3 cycle commodities in the blue packets and other packed in red packets. Stock cards for the two commodities were not properly prepared and no meaningful information could be extracted from the stock cards during this survey.Qualified records assistants should be recruited inHealth Centers.3.2 Data processing was also a problem in all health units due to break down of their computers which were not regularly serviced and/or sufficiently protected from viruses. In addition, costs of photocopying monthly report forms and stock cards were prohibitive to most health units which did not have electricity and had to travel miles to do so. Intermittent electricity supplies further increased costs of photocopying because the photocopying business entities had to 8 8
  9. 9. rely on generators. Transport for delivering reports to the District Health Officers was also a problem since all health units lacked transport facilities. In the rural areas, Health Center staff had to hire bicycles out of the already meager non wage PHC grant. Since the transport line item was not catered for, this delayed delivering accountability reports to the District Health Officers.Health Centers should also be equipped withfunctional data storage and processing equipmentespecially computers with adequate funding forservicing and virus protection.3.3 Record Keeping Facilities: 17 out of the 30 surveyed health units had poor storage facilities for general medical drugs and Family Planning commodities. Storage space was small, lacked shelves and cupboards such that some commodities and drugs were kept on the floor, on top of each other and/or in boxes which according to the in- charges, made it difficult to retrieve the drugs/commodities. Nabuli Health Center III had only 2 delivery notes and all records were kept at the midwife’s home, hence very susceptible to loss.Health Centers should be availed records keepingfacilities notably filing cabinets.4. Transfer of Funds/Materials From The survey revealed that the supply of the Central Level to the Health Units: Family Planning commodities to Health Centers by the National Medical Stores was not streamlined. There were cases of infrequent deliveries to health units that 9
  10. 10. were not based on availability of surplus commodities from previous deliveries but on inaccessibility (hard to reach) of health units, misinformation about closure of some health units and misallocations by the National Medical Stores, whereby some health units received more than was recorded by the National Medical Stores while other units received less than was recorded by the National Medical Stores.National Medical Stores should streamlinethe supply of Family Planning commoditiesto the Health Centers for proper records andaccountability.5. Dispensing of family planning Overall, dispensing constituted only 40.0% commodities at the Health Centers: of what was actually received by health units. In some Health Centers for example Bulangila Health Center III, in Kibuku District, dispensing constituted only 11.3%. In Kamwezi Health Center IV in Kabale, District, it was 28.8%. Nonetheless, all was not grim since Bukinda Health Center III dispensed all the commodities it received, Kamukira Health Center IV also in Kabale District dispensed 83.8% and Kyanamira Health Center III also in Kabale District dispensed 76.4%.Given the low dispensing levels of FP commodities,it is evident that the accountability to communitiesis not effective. Deliberate efforts should be madeto intensify accountability to communities throughsustained IEC campaigns. Targeting males is alsorecommended because most males do not visithealth units and do not attend community health 10
  11. 11. outreaches as much as women do. Hence, healthunit/health outreach settings for dissemination offamily planning IEC do exclude males.Health Unit Management Committees.All health units with the exception of AwachHealth Center IV in Gulu district had HealthUnit Management Committees. All Health UnitManagement Committees were male dominatedand instead of meeting quarterly, 3 had not met atall during FY 2010/2011, citing lack of funds while19 met once or twice during the FY. In addition,none of the minutes of the meetings seen by theresearch team had ever had Family Planning onits agenda. Besides sometimes verifying the types 11
  12. 12. and quantities of Family Planning commoditiesdelivered, Health Unit Management Committeesplayed no oversight roles in the management ofFamily Planning services including participatingin accounting to the District Health Officers andcommunities.The roles of Health Unit Management Committeesin accounting to the District Health Officers andcommunities should be strengthened. 12
  13. 13. The following recommendations are made: AREA RECOMMENDATION ASSESSED Financing Government should substantially Family increase its allocations for family Planning: planning commodities to US $ 7.4 per capita. Government should also procure family planning commodities used by men, especially condoms because implants, IUDs and Depo Provera that Government expenditure on family planning services procures are commodities that can only be used by women. Donors should increase per capita spending on Family Planning commodities to US $ 7.4 Supply Records of the National Medical of family Stores supplies of Family Planning planning commodities to Health centers commodities need to be streamlined to minimize inconsistencies in both National Medical Stores and health center supplies and delivery records. Community Demand for Family Planning awareness commodities amongst and communities should be enhanced utilization through strategies that cover non of family health unit/health outreach settings planning such as community social and commodities economic settings for example markets, agricultural advisory services’ meetings, community halls or even clubs and bars where males are more likely to be found. Family planning IEC could also be packaged and delivered in 13
  14. 14. AREA RECOMMENDATIONASSESSEDCommunity economic and social terms such asawareness linkages between family planningand adoption and economic productivity,utilization financial savings, a planned lifeof family and a more physically vibrant wife,planning children and family as a whole.commodities In the short run, some funds for procuring Family Planning commodities could be diverted from procuring the commodities to conducting IEC campaigns for Family Planning utilization within communities. Once demand increases, the funds could be re-channeled back to purchasing Family Planning commoditiesRecord Qualified records assistants shouldKeeping: be recruited in health centers Health centers should be availed with data storage and processing facilities especially computers with adequate funding for servicing and virus protection Funding for stationery, photocopying and transport to District Health Offices should be availed to reduce delays in forwarding accountability reportsManagement The roles of HUMCs in accountingof family to the District Health Officersplanning and communities should beservices: strengthened. 14
  15. 15. ConclusionOne way of improving safe motherhood indicatorsin Uganda is ensuring that family planning servicesare accessible and utilised. Family planning is oneof the key priority areas of funding for the Ministryof Health (MoH) under its Reproduction HealthDivision. We therefore call upon the Governmentof Uganda to increase funding towards familyplanning services. 15
  16. 16. VISION: A just and fair society where women and men equally participate in and benefit from decision making process MISSION: Promoting gender equality in all areas of decision making through advocacy, training, research and publications. Forum for Women in Democracy (FOWODE) P O BOX 7176, Kampala Tel: + (256) 041 4 286063 Email: Email: Web: 16Where is the money for familyplanning services in uganda 16